ArticlePediatric nephrology (Berlin, Germany)2026
Prevalence and types of anti-neutrophil cytoplasmic antibodies in patients with nephrotic syndrome treated with levamisole.
Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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Who cites it
1 citing paper in PubMed.
- Complications of levamisole therapy in children with nephrotic syndrome: a retrospective study.Pediatric nephrology (Berlin, Germany) · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundLevamisole is a commonly used steroid-sparing medication in pediatric nephrotic syndrome. While use of this agent is associated with development of antineutrophil cytoplasmic antibodies (ANCA), there is limited data on their prevalence and antigen specificity.
methodsThis cross-sectional study, conducted from October 2020 to June 2022, included 117 patients, aged 2-18 years, with steroid-sensitive nephrotic syndrome and receiving levamisole at a dose of 2-2.5 mg/kg on alternate days for ≥ 6-months. All patients were screened for ANCA by indirect immunofluorescence and conventional ELISA. Patients positive on screening underwent profile ELISA to determine its antigen specificity.
resultsTwenty (17.1%) patients tested positive for ANCA by either screening method. On profile ELISA, antibodies showed specificity to myeloperoxidase (n = 13), human neutrophil elastase (n = 6), proteinase-3 (n = 4), and/or their combination (n = 3). Risk factors independently associated with presence of ANCA included female sex [adjusted odds ratio (aOR) 3.1; 95% CI 1.0-9.3; P = 0.044] and cumulative prednisolone intake in the last 6-months [aOR 0.0041; 0.0001-0.21; P = 0.006]. Following levamisole discontinuation, ANCA was negative in all 16 patients who were retested at 40.6 (3-67.2) months. Antinuclear and anticardiolipin antibodies were present in 19 and 8 patients, respectively, and leukopenia in 4 patients.
conclusionsA significant proportion of patients with steroid-sensitive nephrotic syndrome receiving > 6-months' therapy with levamisole show positive ANCA, with antigen specificity against myeloperoxidase, neutrophil elastase and/or proteinase-3. The risk was higher in girls and lower in those receiving concurrent therapy with prednisolone in the past 6-months. Stopping levamisole therapy was associated with resolution of ANCA.
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Registered trials
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